Pancreaticoduodenectomy for MEN1-Zollinger-Ellison syndrome

Early and aggressive surgery of duodenopancreatic neuroendocrine tumors in multiple endocrine neoplasia type 1 patients prevents the development of liver metastases, finds the most recent Annals of Surgery.

A further 20 patients underwent other duodenopancreatic resections, and 2 patients had simple enucleations of duodenopancreatic neuroendocrine tumors.

After median 83 months, the investigators observed that 24 patients were alive and 2 patients died of an unrelated cause.

All patients with insulinoma or vipoma and 7 of 11 patients with Zollinger-Ellison syndrome were biochemically cured.

The investigators noted that the patients who underwent pylorus preserving pancreaticoduodenectomy were also biochemically cured.

However, 19 of 26 patients developed new small duodenopancreatic neuroendocrine tumors less than 1 cm in the pancreatic remnant.

The investigators noted that no patient had yet detectable metastases on imaging.

Dr Bartsch's team commented, “Early and aggressive surgery of duodenopancreatic neuroendocrine tumors in MEN1 patients prevents the development of liver metastases, which are the most life-threatening determinant.”

“Pylorus preserving pancreaticoduodenectomy, might be the procedure of choice for MEN1-Zollinger-Ellison syndrome.”